Healthcare Provider Details

I. General information

NPI: 1790830636
Provider Name (Legal Business Name): JAI R KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 MEDICAL PARK LOOP STE A
SYLVA NC
28779-5271
US

IV. Provider business mailing address

186 MEDICAL PARK LOOP STE 501
SYLVA NC
28779-5222
US

V. Phone/Fax

Practice location:
  • Phone: 828-307-0900
  • Fax: 866-340-6013
Mailing address:
  • Phone: 828-586-5594
  • Fax: 828-586-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9901562
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number9901562
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier891242N
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: